. Gynecology : . ic clinics the dissection method isentirely feasible and preferable. The authors technic is as follows: The fistulous tract is first explored with a fine-probe to determine its direc-tion, whether it is simple or complex, and whether or not it communicates with OPERATIONS ON THE RECTUM 825 lumen of the bowel. A director is then introduced, being brought out throughthe anal orifice if there is a definite opening. If no opening is found, no attemptis made to force it through. With the director in place, an incision is made asshown in Fig. 485. It is on the principle of the so-ca
. Gynecology : . ic clinics the dissection method isentirely feasible and preferable. The authors technic is as follows: The fistulous tract is first explored with a fine-probe to determine its direc-tion, whether it is simple or complex, and whether or not it communicates with OPERATIONS ON THE RECTUM 825 lumen of the bowel. A director is then introduced, being brought out throughthe anal orifice if there is a definite opening. If no opening is found, no attemptis made to force it through. With the director in place, an incision is made asshown in Fig. 485. It is on the principle of the so-called apron incision for complete tear ofthe sphincter originally devised by J. C. Warren, and is designed to protect thewound as much as possible from contamination from the anal orifice. A semicircular incision is made through the skin outside the border of theanus. At right angles to this an incision is made to the fistulous opening alongthe course of the director. On reaching the fistulous opening the incision. Fia. 485.—Operation for Fistula in Ano (Authors Method).Dissection of the tract. A director is introduced into the fistulous opening. The red line indicates the fine of incision. encircles it with a margin of about \ inch. Through the incision thus outlinedthe fistula is now dissected out as a tube surrounding the director (Fig. 486).In order to keep the fistula tense for the purpose of dissection it is seized at itsend with a pair of toothed clamps, by which it can be held in a convenientposition; the dissection is then carried to the end of the fistula. If there areramifications of the fistulous tract, these are also dissected out. As little damageis done to the fibers of the-sphincter muscle as possible, it being unnecessarysometimes to cut them at all. If the fistula has entered the lumen of the bowel the opening is first closedwith fine catgut sutures applied from the wound side. If the sphincter has been 826 GYNECOLOGY injured, fine catgut sutures are placed i
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